Advertisement

Pediatric Radiology

, Volume 49, Issue 1, pp 105–113 | Cite as

Non-contrast-enhanced magnetic resonance angiography for detecting crossing renal vessels in infants and young children: comparison with contrast-enhanced angiography and surgical findings

  • Fiammetta Sertorio
  • Michela Cing Yu Wong
  • Veronica Incarbone
  • Angela Pistorio
  • Girolamo Mattioli
  • Gian Michele Magnano
  • Maria Beatrice Damasio
Original Article

Abstract

Background

Knowing that ureteropelvic junction obstruction is due to a crossing renal vessel is essential in choosing the appropriate surgical treatment.

Objective

To evaluate the diagnostic accuracy of non-contrast magnetic resonance (MR) angiography in identifying crossing renal vessels in children younger than 4 years old with unilateral hydronephrosis.

Materials and methods

A retrospective review of preoperative MR urography of children with unilateral hydronephrosis was conducted by two independent readers. The presence or absence of crossing renal vessels was identified and compared with surgical findings.

Results

Twenty-nine patients were included. The disagreement between MR angiography with and without contrast enhancement in detecting a crossing renal vessel was 8%. The disagreement between non-contrast-enhanced MR and surgical findings was 17%. The disagreement between contrast-enhanced MR angiography and surgical findings was 25%. The balanced triggered angiography without contrast enhancement had a sensitivity of 70% (95% confidence interval [CI]: 35-93%) and a specificity of 93% (95% CI: 66-100%). Contrast-enhanced MR angiography had a sensitivity of 56% (95% CI: 21-86%) and a specificity of 91%. (95% CI: 59-100%).

Conclusion

MR without contrast enhancement may be a reliable, valid and safe alternative to contrast-enhanced MR angiography for identifying crossing renal vessels.

Keywords

Children Crossing renal vessel Hydronephrosis Magnetic resonance angiography Non-enhanced magnetic resonance imaging 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Rigas A, Karamanolakis D, Bogdanos I et al (2003) Pelvi-ureteric junction obstruction by crossing renal vessels: clinical and imaging features. BJU Int 92:101–103CrossRefGoogle Scholar
  2. 2.
    Guven A (2016) Crossing renal vessel causing ureteropelvic junction obstruction in children. J Integr Nephrol Androl 3:31–32CrossRefGoogle Scholar
  3. 3.
    Richstone L, Seldeman CA, Reggio E et al (2009) Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology 73:716–719CrossRefGoogle Scholar
  4. 4.
    Calder AD, Hiorns MP, Abhyankar A et al (2007) Contrast-enhanced magnetic resonance angiography for the detection of crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with operative findings. Pediatr Radiol 37:356–361CrossRefGoogle Scholar
  5. 5.
    Pavicevic PK, Saranovic DZ, Mandic MJ et al (2015) Efficacy of magnetic resonance urography in detecting crossing vessels in children with ureteropelvic junction obstruction. Ann Ital Chir 86:443–449Google Scholar
  6. 6.
    Weiss DA, Kadakia S, Kurzweil R et al (2015) Detection of crossing vessels in pediatric ureteropelvic junction obstruction: Clinical patterns and imaging findings. J Pediatr Urol 11:173.e1–173.e5CrossRefGoogle Scholar
  7. 7.
    Rooks VJ, Lebowitz RL (2001) Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol 31:120–124CrossRefGoogle Scholar
  8. 8.
    Veyrac C, Baud C, Lopez C et al (2003) The value of colour Doppler ultrasonography for identification of crossing vessels in children with pelvi-ureteric junction obstruction. Pediatr Radiol 33:745–751CrossRefGoogle Scholar
  9. 9.
    Mitterberger M, Pinggera GM, Neururer R et al (2008) Comparison of contrast-enhanced color Doppler imaging (CDI), computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of crossing vessels in patients with ureteropelvic junction obstruction. Eur Urol 53:1254–1260CrossRefGoogle Scholar
  10. 10.
    Mitsumori A, Yasui K, Akaki S et al (2000) Evaluation of crossing vessels in patients with ureteropelvic junction obstruction by means of helical CT. Radiographics 20:1383–1393CrossRefGoogle Scholar
  11. 11.
    Park SY, Kim CK, Kim E, Park BK (2015) Noncontrast-enhanced magnetic resonance renal angiography using a repetitive artery and venous labelling technique at 3 T: comparison with contrast-enhanced magnetic resonance angiography in subjects with normal renal function. Eur Radiol 25:533–540CrossRefGoogle Scholar
  12. 12.
    Glockner JF, Takahashi N, Kawashima A et al (2010) Non-contrast renal artery MRA using an inflow inversion recovery steady state free precession technique (Inhance): comparison with 3D contrast-enhanced MRA. J Magn Reson Imaging 31:1411–1418CrossRefGoogle Scholar
  13. 13.
    Brucher N, Vial J, Baunin C et al (2016) Non-contrast-enhanced MR angiography using time-spin labelling inversion pulse technique for detecting crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with surgical findings. Eur Radiol 26:2697–2704CrossRefGoogle Scholar
  14. 14.
    Vivier PH, Dolores M, Taylor M, Dacher JN (2010) MR urography in children. Part 2: how to use ImageJ MR urography processing software. Pediatr Radiol 40:739–746CrossRefGoogle Scholar
  15. 15.
    Antonov NK, Ruzal-Shapiro CB, Morel KD et al (2016) Feed and wrap MRI technique in infants. Clin Pediatr 56:1095–1103CrossRefGoogle Scholar
  16. 16.
    Radmayr C, Bogaert G, Dogan HS et al. (2018) EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen. ISBN 978-94-92671-01-1Google Scholar
  17. 17.
    Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480CrossRefGoogle Scholar
  18. 18.
    Gupta M, Smith AD (1998) Crossing vessels. Endourologic implications. Urol Clin North Am 25:289–293CrossRefGoogle Scholar
  19. 19.
    Hoffer FA, Lebowitz RL (1985) Intermittent hydronephrosis: a unique feature of ureteropelvic junction obstruction caused by a crossing renal vessel. Radiology 156:655–658CrossRefGoogle Scholar
  20. 20.
    Sampaio FJ (1991) Relationship between segmental arteries and pelviureteric junction. Br J Urol 68:214–217CrossRefGoogle Scholar
  21. 21.
    Sampaio FJ, Favorito LA (1993) Ureteropelvic junction stenosis: vascular anatomical background for endopyelotomy. J Urol 150:1787–1791CrossRefGoogle Scholar
  22. 22.
    Van Cangh PJ, Nesa S, Galeon M et al (1996) Vessels around the ureteropelvic junction: significance and imaging by conventional radiology. J Endourol 10:111–119CrossRefGoogle Scholar
  23. 23.
    Pesce C, Campobasso P, Costa L et al (1999) Ureterovascular hydronephrosis in children: Is pyeloplasty always necessary? Eur Urol 36:71–74CrossRefGoogle Scholar
  24. 24.
    Sakoda A, Cherian A, Mushtaq I (2011) Laparoscopic transposition of lower pole crossing vessels (‘vascular hitch’) in pure extrinsic pelvi-ureteric junction (PUJ) obstruction in children. BJU Int 108:1364–1368CrossRefGoogle Scholar
  25. 25.
    Jones RA, Grattan-Smith JD, Little S (2011) Pediatric magnetic resonance urography. J Magn Reson Imaging 33:510–526CrossRefGoogle Scholar
  26. 26.
    Napolitano M, Damasio MB, Grumieri G (2012) Ruolo dell’uro-risonanza magnetica in urologia pediatrica: stato dell’arte. (Role of magnetic resonance urography in pediatric urology: state of the art). Prospettive in pediatria (rivista della Società Italiana di Pediatria) 42:163-169Google Scholar
  27. 27.
    McDaniel BB, Jones RA, Scherz H et al (2005) Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: anatomic and functional assessment of ureteropelvic junction obstruction. AJR Am J Roentgenol 185:1608–1614CrossRefGoogle Scholar
  28. 28.
    Jones RA, Easley K, Little SB et al (2005) Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: functional assessment. AJR Am J Roentgenol 185:1598–1607CrossRefGoogle Scholar
  29. 29.
    Ramalho J, Semelka RC, Ramalho M et al (2016) Gadolinium-based contrast agent accumulation and toxicity: an update. AJNR Am J Neuroradiol 37:1192–1198CrossRefGoogle Scholar
  30. 30.
    Beomonte Zobel B, Quattrocchi CC, Errante Y, Grasso RF (2016) Gadolinium-based contrast agents: did we miss something in the last 25 years? Radiol Med 121:478–481CrossRefGoogle Scholar
  31. 31.
    Grobner T (2006) Gadolinium: a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 21:1104–1108CrossRefGoogle Scholar
  32. 32.
    Marckmann P, Skov L, Rossen K et al (2006) Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 17:2359–2362CrossRefGoogle Scholar
  33. 33.
    Flood TF, Stence NV, Maloney JA, Mirsky DM (2017) Pediatric brain: repeated exposure to linear gadolinium-based contrast material is associated with increased signal intensity at unenhanced T1- weighted MR imaging. Radiology 282:222–228CrossRefGoogle Scholar
  34. 34.
    Hu HH, Pokorney A, Towbin RB, Miller JH (2016) Increased signal intensities in the dentate nucleus and globus pallidus on unenhanced T1-weighted images: evidence in children undergoing multiple gadolinium MRI exams. Pediatr Radiol 46:1590–1598Google Scholar
  35. 35.
    Roberts DR, Chatterjee AR, Yazdani M et al (2016) Pediatric patients demonstrate progressive T1-weighted hyperintensity in the dentate nucleus following multiple doses of gadolinium-based contrast agent. AJNR Am J Neuroradiol 37:2340–2347CrossRefGoogle Scholar
  36. 36.
    Rossi Espagnet MC, Bernardi B, Pasquini L et al (2017) Signal intensity at unenhanced T1-weighted magnetic resonance in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in children. Pediatr Radiol 47:1345–1352CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Radiology Department, IRCCS Istituto Giannina GasliniUniversity of GenoaGenoaItaly
  2. 2.University of GenoaGenoaItaly
  3. 3.Pediatric Surgery DepartmentIRCCS Istituto Giannina GasliniGenoaItaly
  4. 4.Radiology DepartmentUniversity of InsubriaVareseItaly
  5. 5.Epidemiology, Biostatistics and Committees Unit, IRCCS Istituto Giannina GasliniUniversity of GenoaGenoaItaly

Personalised recommendations